Governor Signs Bill to Codify Licensure Exemptions

capitol building

On Dec. 27, Gov. Gretchen Whitmer signed into law Senate Bill (SB) 759, which codifies a licensure exemption provision that has given hospitals regulatory flexibility to appropriately respond to the pandemic, specifically staffing challenges.

The new law took effect immediately and allows licensed, out-of-state providers who are in good standing the ability to render clinical care in Michigan without a Michigan license during an “epidemic-related staffing shortage” as currently identified by the Michigan Department of Health and Human Services.

MHA CEO Brian Peters released a statement Dec. 14 applauding lawmakers for prioritizing the bill. The provision that was previously in place, activated by the Department of Licensing and Regulatory Affairs, was originally set to expire Jan. 11. Members with questions may contact Adam Carlson at the MHA.

Governor Signs Supplemental Hospital Funding into Law

capitol building

Gov. Gretchen Whitmer signed a supplemental budget bill July 26, appropriating $160 million in funding for Michigan hospitals that is intended to account for the cost of treating COVID-19 patients throughout the pandemic. Senate Bill (SB) 27, introduced by Sen. Jim Stamas (R-Midland), was passed by the Legislature earlier in July and supported by the MHA.

The press release announcing the bill’s signing quoted MHA CEO Brian Peters, who said, “Michigan hospitals have experienced significant financial hardships while caring for over 125,000 COVID-19 patients over the past 16 months of the pandemic. We want to thank our partners in the Legislature and Gov. Whitmer for passing this supplemental allocation that will help hospitals maintain access to care for Michigan residents throughout our state.”

The MHA will continue to work with the Michigan Department of Health and Human Services on the distribution of the funding. Any questions on SB 27 or other budget-related issues can be directed to Adam Carlson at the MHA.

Combating the Novel Coronavirus (COVID-19): Week of Oct. 5

MHA Covid-19 update

MHA COVID-19 UpdateWith the Oct. 2 Michigan Supreme Court ruling that the legal basis for Gov. Gretchen Whitmer’s COVID-19-related executive orders is unconstitutional, a greater degree of uncertainty surrounds the ways Michigan hospitals, businesses and residents are responding to the challenges of the continuing pandemic. The MHA is keeping members apprised of this and other pandemic-related developments affecting Michigan hospitals through email updates and the MHA Coronavirus webpage. The Supreme Court ruling and additional important updates are outlined below.

MHA Evaluating Impact of Supreme Court Striking Down Governor’s State of Emergency Powers

The Michigan Supreme Court’s ruling declaring the legal basis for the governor’s COVID-19-related executive orders unconstitutional was in response to a request from the U.S. District Court for the Western District of Michigan. The lower court asked for a review of the constitutionality of two Michigan statutes Whitmer relied on in issuing her executive orders, the Emergency Management Act (EMA) of 1976 and the Emergency Powers of the Governor Act (EPGA) of 1945. The Michigan Supreme Court unanimously ruled the governor lacked authority to issue or renew executive orders under the EMA after April 30, 2020, without concurrence by the Legislature. By a 4-3 margin, the court ruled the EPGA also violated the Michigan Constitution.

The current executive orders (EOs) remain in effect until at least Oct. 23 because, under Michigan Court Rules, orders of the Michigan Supreme Court are not effective sooner than 21 days, allowing the opportunity for a party to request a rehearing. However, this was not a routine appeal from the Michigan Court of Appeals or through the Michigan state courts. Because this was a certified question from the federal court, the U.S. District Court will now need to issue an opinion in the federal case that prompted the Supreme Court’s ruling, Midwest Institute of Health v. Governor. The timing for this decision is unknown.

The MHA posted a statement on the ruling on its website, encouraging all Michiganders to continue to be extremely vigilant about following COVID-19 prevention guidance, including masking, physical distancing, washing hands frequently and receiving flu vaccines.

It is anticipated that many of the healthcare-related orders will be implemented through state regulatory agencies and local/county government agencies. Michigan Department of Health and Human Services (MDHHS) Director Robert Gordon issued an Emergency Order Oct. 5 that mandates masks in public places and limits gathering sizes. The MHA is reviewing the order and will alert members if its effects are expected to be different than those experienced under the governor’s orders. The association will also apprise members of any additional state-level announcements as they become available.

An updated list of the governor’s EOs that impact members is available on the MHA website to ensure hospitals are aware of potential items the healthcare community may need have addressed; all EOs and MDHHS orders are available on the state's COVID-19 webpage.

CMS Revises Reporting Requirements

The Centers for Medicare & Medicaid Services (CMS) issued new guidance on COVID-19 reporting requirements and a workflow process that outlines how the CMS will enforce hospital compliance. Hospitals are encouraged to read the revised guidance and note the following changes from previous requirements:

  • Mandatory supply-related data reports are now required once per week.
  • Psychiatric (except those that are distinct-part psychiatric hospitals) and rehabilitation hospitals will be required to report only once per week.
  • Beginning Nov. 1, remdesivir and staffing-related data will be optional.
  • Additional reporting requirements will begin Nov. 1 for certain data on influenza patients.

Hospitals are also required to provide data into the state’s COVID-19 data portal, EMResource. Hospitals may choose to allow the state to enter data into the U.S. Department of Health and Human Services’ TeleTracking COVID-19 portal on their behalf. Members with questions about this process or the CMS guidelines may contact Jim Lee at the MHA.

Medicare Advance Payment Repayment Update

WPS, the Medicare Administrative Contractor (MAC) for most of Michigan, recently released information regarding the CMS’ instructions to MACs to implement the provision of the Continuing Appropriations Act of 2021 delaying the Medicare advance payment repayment timeline. Changes to the repayment terms are as follows:

  • The repayment period has been extended, and the automatic recoupment will begin one year after the date the accelerated or advance payment was issued.
  • During the first 11 months after repayment begins, repayment will occur through an automatic recoupment of 25% of the provider/supplier Medicare payments.
  • At the end of the 11-month period, the recoupment rate will increase from 25% to 50%. The automatic recovery at the 50% recoupment rate will continue for six months.
  • If the total amount of the accelerated/advance payment is not recovered within 29 months from the date the payment was made, a demand letter for the outstanding balance will be issued. The demanded amount will be subject to a 4% interest rate.

The MHA will continue to work with the Michigan congressional delegation and the American Hospital Association to further improve these processes. Members with questions may contact Jason Jorkasky at the MHA.

Governor Announces Broadband Internet Grants

The governor announced Oct. 8 during the North American International Cyber Summit that $12.7 million in funding is available to increase broadband internet access across Michigan. As telehealth and remote work have gained popularity during the COVID-19 pandemic, this effort to improve internet access is welcomed by members – especially those in rural areas.

According to the announcement, more than 1,243,000 Michigan households do not have a permanent, fixed broadband connection at home, resulting in $1.8 billion to $2.7 billion in potential economic benefit left unrealized among disconnected households.

The new broadband projects were selected through the Connecting Michigan Communities (CMIC) grant program and are expected to extend access to more than 10,900 households, businesses and community anchor institutions in Michigan. A list of counties/areas impacted by these awards is available on the CMIC Broadband Grant webpage. Recommendations for the second round of CMIC grant awards totaling $5.3 million will be announced soon, and the governor recently signed a state budget that includes an additional $14.3 million in grant funding for a third round of projects in 2021.

Additional information on the COVID-19 pandemic is available to members on the MHA Community Site and the MHA COVID-19 webpage. Questions on COVID-19 and infectious disease response strategies may be directed to the MDHHS Community Health Emergency Coordination Center (CHECC). Members with MHA-specific questions should contact the following MHA staff members:

Combating the Novel Coronavirus (COVID-19): Week of Aug. 17

MHA Covid-19 update

MHA Coronavirus UpdateThe MHA continues to keep members apprised of developments affecting Michigan hospitals during the pandemic through email updates and the MHA Coronavirus webpage. Important updates are outlined below.

New COVID-19 Viral Testing Required for Medicare Add-on Payment

The Coronavirus Aid, Relief, and Economic Security (CARES) Act provided for a 20% add-on to the inpatient prospective payment system diagnosis-related group rate for patients diagnosed with COVID-19 for the duration of the public health emergency. The Centers for Medicare & Medicaid Services (CMS) recently updated its guidance related to this add-on payment.

For inpatient admissions occurring on or after Sept. 1, 2020, claims eligible for the 20% add-on must have a positive COVID-19 laboratory test documented in the medical record. This is in addition to previously required International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) diagnosis codes.

While the CMS will continue to apply the 20% payment add-on based on the diagnosis codes noted in the guidance, it may conduct post-payment medical reviews to confirm the presence of a positive COVID-19 test in the medical record. If no such test is present, the additional payment resulting from the 20% add-on will be recouped.

Members with questions may contact Vickie Kunz at the MHA.

Update on CMS Survey Activity

The CMS also issued an update on resuming survey activities of healthcare facilities. The guidance encourages states to resume survey activity for non-long-term care settings. It provides some detail about the areas of focus of these surveys, how states should approach surveys underway prior to the public health emergency, long-term care settings and more. Members are encouraged to review the guidance for additional details as they prepare for future survey activity.

In follow-up to this CMS guidance and as an update since the webinar that the MHA hosted with The Joint Commission in mid-June, the commission has outlined the latest on its surveyor recovery plan and approach to telehealth.

The information from both the CMS and The Joint Commission are available through the Aug. 20 update the MHA emailed to members.

Testing Requirement for Department of Corrections Staff

The Michigan Department of Health and Human Services (MDHHS) Aug. 19 issued an Emergency Order requiring COVID-19 testing for Michigan Department of Corrections (MDOC) staff. Gov. Gretchen Whitmer also recently issued Executive Order 2020-170 to require that prisons and jails take preventive measures to decrease the spread of COVID-19, including testing at entry, transfer and release of any prisoner.

Under the Aug. 19 Emergency Order, which took immediate effect, prisons operated by the MDOC must use testing protocols for anyone who works within the physical boundaries of the prison or comes into contact with prisoners while on the job. All prisons operated by the MDOC must take specific mitigation steps immediately when a staff person tests positive for COVID-19 or is exposed to the virus.

Additional information on the COVID-19 pandemic is available to members on the MHA Community Site and the MHA COVID-19 webpage. Questions on COVID-19 and infectious disease response strategies may be directed to the MDHHS Community Health Emergency Coordination Center (CHECC). Members with MHA-specific questions should contact the following MHA staff members:

Combating the Novel Coronavirus (COVID-19): Week of Aug. 10

MHA Covid-19 update

The MHA continues to keep members apprised of developments affecting Michigan hospitals during the pandemic through email updates and the MHA Coronavirus webpage. Important updates are outlined below.

Number of Michigan COVID-19 Cases Has Plateaued

Gov. Gretchen Whitmer announced during an Aug. 14 news conference that there have been 90,392 confirmed cases of COVID-19 in Michigan and 6,289 deaths. Currently, the state ranks 40th in the seven-day average of new COVID-19 cases per capita across the country and is 40th in the percentage of those testing positive on COVID-19 diagnostic tests. Although residents need to continue to follow recommended precautions, the number of Michigan’s new cases has plateaued, with the average infection rate reported as being half that of neighboring Midwest states. Testing continues to expand statewide, with 38,000 tests reported in one day and an average positive case rate of 3.2%.

MI Mask Aid Project to Provide 4 Million Free Masks to Needy Michiganders

The governor Aug. 14 announced the MI Mask Aid project, a partnership between the Federal Emergency Management Agency (FEMA) and Ford Motor Co. that will distribute 4 million free masks to those in need, including low-income students and minorities. FEMA has already sent 1.5 million masks to organizations that include local Community Action Agencies serving low-income residents, Michigan Department of Health and Human Services (MDHHS) offices, Area Agencies on Aging, homeless shelters and Native American tribes. Another 1 million face coverings from FEMA and 1.5 million from Ford will go to low-income schools, the City of Detroit, Federally Qualified Health Centers, some COVID-19 testing sites and to many of the organizations listed above to reach vulnerable populations — including minority residents who have been affected by the public health crisis due to racism. Mask distribution site information is available from the state COVID-19 hotline at (888) 535-6136 or through a Community Action Agency.

Additional information on the COVID-19 pandemic is available to members on the MHA Community Site and the MHA COVID-19 webpage. Questions on COVID-19 and infectious disease response strategies may be directed to the MDHHS Community Health Emergency Coordination Center (CHECC). Members with MHA-specific questions should contact the following MHA staff members: